NO PERMIT NUMBER NO. STRRRT
APPLICATION FOR PLUMBING PERMIT
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° Application is hereby made to t /C�tEbf (at/Fielt/tuIDfor 'nit to install plumbing
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° CONTRACTOR, AGENT
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a o Stare License Approved _ to
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— / PLUMBING INSPECTOR
FI? I URES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
TOW Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb- Sinks Trays To Curb
Dental Units
Drin ing Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
an taps TOTAL EES
FrInals Fixture Fee
rea rains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final